1114002441 NPI number — DR. SALVATORE INSERRA MD

Table of content: DR. SALVATORE INSERRA MD (NPI 1114002441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114002441 NPI number — DR. SALVATORE INSERRA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INSERRA
Provider First Name:
SALVATORE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114002441
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 RESEARCH WAY
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
EAST SETAUKET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11733-6401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-675-2125
Provider Business Mailing Address Fax Number:
631-675-2624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 MIDDLE COUNTRY RD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
SMITHTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-360-2200
Provider Business Practice Location Address Fax Number:
631-360-1328
Provider Enumeration Date:
10/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  145138-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0919077 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4288391 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0069854 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 14D891 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 488345 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00821572 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200008348 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2C1476 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: W21941 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CS142 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 14D891 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".